Effect Of Driving Pressure-guided Lung Protective Ventilation On Patients Undergoing Laparoscopic Radical Gastrectomy For Gastric Cancer

Objective:To compare the effects of driving pressure（ΔP）-guided lung protective ventilation and traditional lung protective ventilation on respiratory Pulmonary function and postoperative pulmonary complications（PPCs）in patients undergoing laparoscopic radical gastrectomy,and to explore the choice of optimal positive end-expiratory pressure（PEEP）.Methods:A total of 50 patients undergoing elective laparoscopic radical gastrectomy under general anesthesia were selected and randomly divided into driving pressure group and traditional group.Drive pressure group（n=25）:optimal PEEP was titrated using drive pressure;traditional group（n=25）:PEEP was fixed at 5 cm H₂O,and the other ventilation parameters were consistent.Invasive arterial blood pressure,heart rate,peak airway pressure,airway plateau pressure,positive end-expiratory pressure,and partial pressure of end-tidal carbon dioxide were recorded at various time points:10 min after the firstΔP titration PEEP（T1）and 10 min,1 h,and 2 h after the secondΔP titration PEEP（T2–T4）in the driving pressure group;10 min after PEEP setting（T1）and 10 min,1 h,and 2 h after pneumoperitoneum position change（T2–T4）in the traditional group;arterial blood was collected from T1–T4 for blood gas analysis and blood gas parameters were recorded to calculate the oxygenation index,lung compliance,driving pressure,and dead space rate.Arterial blood gas analysis indicators were recorded before surgery（T0）,1 day after surgery（T5）,3 days after surgery（T6）and 7 days after surgery（T7）in both groups;the incidence of pulmonary complications（PPCs）and postoperative hospital stay were followed up and recorded 7 days after surgery in both groups.Results:In the driving pressure group,PEEP was titrated 6.8±0.5 cm H₂O after endotracheal intubation and 8.2±0.76 cm H₂O again after pneumoperitoneum position change.The comparison of intraoperative respiratory function and circulatory parameters showed that:the oxygenation index and arterial partial pressure of oxygen in the driving pressure group were higher than those in the traditional group at T3 and T4（P<0.05）;the lung compliance in the driving pressure group was higher than that in the traditional group at T1-T4（P<0.05）;theΔP in the driving pressure group was lower than that in the traditional group at each time point（P<0.05）;the plateau pressure in the driving pressure group was higher than that in the traditional group at T2,T3 and T4（P<0.05）;there was no statistical difference in the dead space rate,arterial partial pressure of carbon dioxide,mean arterial pressure and heart rate at T1-T4 between the two groups（P>0.05）.Comparison of postoperative pulmonary complications and blood gas analysis showed:the incidence rate of PPCs in driving pressure group was lower than that in traditional group（P<0.05）;the oxygenation index and arterial partial pressure of oxygen in driving pressure group were higher than those in traditional group at T5（P<0.05）;there was no statistical difference in oxygenation index and arterial partial pressure of oxygen between the two groups at T6 and T7（P>0.05）;there was no statistical difference in postoperative hospital stay between the two groups（P>0.05）.Conclusion:Compared with conventional lung-protective ventilation,driving pressure-guided lung-protective ventilation can improve the respiratory function and oxygenation level of patients during surgery and 1 day after surgery,reduce the incidence of PPCs 7 days after surgery,without increasing the occurrence of other adverse reactions;the mechanism may be related to factors such as reducing intraoperative driving pressure,improving lung compliance,and reducing atelectasis.